College of Surgeons, Singapore

Overview of Paediatric Surgery in Singapore

In Singapore, surgery in children was in the hands of general surgeons until very recently. In the 50's and 60's Professor Yeoh Ghim Seng and Dr Yahya Cohen headed 'A' and 'B' units respectively in the Singapore General Hospital.

Since 1997, we have been housed in a dedicated children's hospital. For it is only in such a setting that we can give the best and most appropriate care to our patients. Recently the Paediatric Surgical service at the National University Hospital has also developed into a separate Department of Pediatric Surgery.

The advanced training programme with the recognition of Pediatric Surgery as a separate specialty was started in the late 80's.

What has changed over the years in Pediatric Surgery? The specialty has developed hand in hand with Pediatric Anaesthesia, Neonatal and Pediatric Intensive Care. This has allowed us to safely perform life saving surgery on babies as small as 5 - 600 gm.

Miniaturization of instruments and supplies has gone hand in hand with the use of operating loupes and microscopes. This allows very precise and minutely detailed surgery to be carried out for the smallest neonates, and for replantation surgery. While many surgical techniques have remained unchanged, minimally invasive techniques are gaining ground. The number of procedures now done via a MIS approach are increasing by the day which translates to quicker recovery, less need for analgesia, and quicker return to normal activities and play. In the long run we also envisage that a minimally invasive approach will translate to fewer admissions for adhesive obstructions and other late morbidities relating to open surgery. Surgical conditions are in general diagnosed earlier, and we attempt to restore normality as early as possible. The quick recovery and excellent outcomes have convinced all our surgeons this is an excellent approach to restore early normality to the baby which translates to long term normal function.

In order to progress and improve, subspecialisation is necessary. This will however be within the confines of a limited patient population in Singapore. Further development in Minimally invasive surgery will push the limits, with robotics obviating the need for the surgeon to be physically present in the OT. With subspecialisation and by keeping a training focus, we will continue to keep the specialty growing and energetic to serve the children.

Message from the Chapter Chairman, Dr Chui Chan Hon

Paediatric surgeons form a small but closely-knitted specialty. The Chapter of Paediatric Surgeons currently comprises of paediatric surgeons in both the public and private sectors. With the Ministry of Health’s decision to increase the number of advanced paediatric surgical trainees, we are looking forward to a larger paediatric surgical community in the near future. Paediatric Surgery is an extremely broad specialty. Together with the limited patient population in Singapore, keeping up with the new standards of care and cutting-edge therapies can be challenging. We have previously recognized the importance of subspecialisation in improving the standard of care in paediatric surgery, an approach that was initiated by paediatric surgeons in many developed countries. Many paediatric surgeons have since been for subspecialty training in renowned centres overseas and have returned to serve in our local community. Such subspecialties include urology, surgical oncology, minimally invasive surgery and transplantation surgery. We will be focusing on such subspecialty programs in our Continuing Professional Education (CPE) programs in the next 2 years, aimed at sharing cutting-edge management and techniques, and collaborations in research.